Objective To estimate the prevalence of severe stress urinary incontinence (SUI) among perimenopausal women and to examine potential obstetric risk factors. Design Mail survey of female volunteers for epidemiological research.Setting Postal questionnaire on SUI.Population Three thousand one hundred and fourteen women aged 49 -61 years who comprised the GAZEL cohort. Methods Logistic regression using data from the entire cohort to estimate the impact of risk factors. A second logistic regression using data from women who had given birth included obstetric history. Main outcome measure Prevalence of severe SUI defined by the response 'often' or 'all the time' to the question 'Does urine leak when you are physically active, cough or sneeze?' Results Two thousand six hundred and twenty-five women (85%) completed and returned the questionnaireThe frequency of SUI reported in the preceding four weeks was as follows: 'never' 32%, 'occasionally' 28%, 'sometimes' 26%, 'often' 10% and 'all the time' 5%. Prevalence of severe SUI was lowest among nulliparous women (7%), but it was similar among parous women regardless of birth number (14 -17%). The prevalence of severe SUI was not associated with mode of delivery (14% for women delivered by caesarean only vs 16% for vaginal births). Significant risk factors for severe SUI were high body mass index (BMI >30), diabetes mellitus, previous incontinence surgery, parity and first delivery under the age of 22 years. Conclusion Previous pregnancy itself is a risk factor for severe SUI among women who reach the age of 50.In this age group the impact of the mode of delivery (spontaneous, forceps or caesarean) on severe SUI is slight.

Three hundred patients were enrolled in a double-blind, randomized, controlled study designed to investigate the ability of supplemental perioperative oxygen to reduce wound infection. Participants were age 18 to 80 years, had no coexisting serious medical conditions, and were scheduled to undergo elective colorectal surgery at one of 14 participating hospitals in Spain. No patients undergoing minor or laparoscopic surgery were included. Anesthesia and antibiotic prophylaxis were standardized for the study. Patients were randomized by computer-generated codes to receive an oxygen/air mixture of 30% or 80% fraction of inspired oxygen (F10 2 ) intraoperatively and postoperatively for 6 hours. After 6 hours, oxygen was given only in amounts needed to maintain 92% saturation. Postoperative care was determined by the attending surgeon who was unaware of the patient's oxygen group.Wounds were inspected daily and surgical site infections (SSI) were diagnosed according to the definitions of the Centers for Disease Control and Prevention. Infections occurring during the first 14 days were considered for analysis.Nine patients did not meet inclusion criteria. Of the remaining 291 patients, 143 received 30% and 148 received 80% oxygen. The 2 groups were similar in clinical characteristics, including preoperative laboratory studies and risk of infection score. Surgical characteristics, including length of operative procedure, blood loss, and transfusion rate, were also similar between the 2 groups.Fifty-seven patients (19.3%) developed a wound infection. The incidence of wound infection was 35 of 143 (24%) in the 30% F10 2 group and 22 of 148 (14.9%) in the 80% F10 2 patients (P ϭ 0.04). The risk of SSI was 39% lower in the high oxygen group compared with those who received less oxygen (relative risk, 0.61; 95% confidence interval [CI], 0.38-0.98). Other measures of surgical outcome, including return of bowel function, ability to tolerate solid food, ambulation, suture removal, and duration of hospitalization, were not significantly different for the 2 treatment groups. When patients who developed wound infections were compared with those without infection, the group with SSI had a longer time to ambulation (mean, 4.9 vs 3.9 days; P ϭ 0.008), a longer time to staple removal (11.6 vs 10.1 days; P ϭ 0.007), and were in the hospital longer (15.1 vs 10.7 days; P ϭ 0.001).Two patients, both in the 30% oxygen group, died of sepsis during the study period. After multivariate analysis of possible confounding variables, the relative risk of wound infection in patients who received 80% oxygen was 0.46 (95% CI, 0.22-0.95; P ϭ 0.04) compared with those who received 30% oxygen. EDITORIAL COMMENT(In the United States these days, surgical wound infection occurs after less than 1% of abdominal or vaginal hysterectomies. This is a marked reduction in the last 20 years brought about largely because of prophylactic antibiotics. More than 25 prospective, randomized studies have shown the effectiveness of prophylactic antibiotics in reducing pos...

Decision to treat with an anti-osteoporotic drug should be based on individual fracture risk evaluation. We compared the discriminant value of four different screening strategies to identify elderly women with a risk of hip fracture greater than 20 per 1000 woman-years: (1) BMD screening alone, (2) quantitative ultrasound (QUS) screening alone, (3) QUS triage followed by BMD assessment for women with medium-low QUS parameters, and (4) selective BMD screening based on weight followed by clinical evaluation for women with medium-low BMD. The study population included 5910 women aged 75 years or older who participated to the EPIDOS (Epidemiologie de l'Ostéoporose) prospective study. Over an average of 3.7 (+/-0.8) years of follow-up, 231 women suffered a hip fracture, which corresponds to an average risk of 10.6 per 1000 woman-years. All strategies allow us to clearly distinguish a group at high risk of hip fracture (i.e. >20 per 1000 woman-years) from a group at low risk (i.e. below the average risk in the cohort). QUS screening alone has a very low sensitivity (15%). The strategy using QUS as a method of triage and that combining selective BMD and clinical assessment have a sensitivity equivalent to systematic BMD screening (around 35%), with less than 50% BMD examinations. The high-risk women identified by these two strategies are not the same. A simple algorithm combining QUS, BMD, and clinical risk assessment allows an increased number of high-risk women to be identified (21%), and thus improves the sensitivity (53%). With this combined strategy, women in the high-risk group have one chance in ten of having a hip fracture over the next 4 years, whereas women in the low risk group have only one chance in 40.

Social relations were associated with psychological and breast symptoms, but not with HFs. The strong association between common symptoms and HFs suggests that biomedical factors have a greater influence than social relations on the occurrence of HFs.

A triage strategy, based on a clinical hip fracture risk score, may be used to classify elderly women into three groups: one at high risk and requiring treatment, another needing further assessment by bone densitometry, and a third at low risk. We used prospective data from the EPIDOS study (7512 women older than 75 years and followed for an average of 3.9 years) to assess the potential value of such a strategy for identifying elderly women with a hip fracture risk twice the cohort average (i.e. > or =20 per 1000 woman-years). An individual fracture risk score was calculated with the final risk function (Cox model). To compare this strategy with systematic BMD measurement and with current European recommendations, we examined the number of high-risk women identified, their average risk levels, sensitivity for hip fracture, and the number of high-risk women who need to be treated to prevent one hip fracture (hypotheses: all identified women are treated; sensitivity is equal to the point estimate; treatment reduces fracture risk by 35%). A triage strategy based on age, fracture history since the age of 40 years, body mass index, number of instrumental activities of daily living for which assistance is needed, grip strength, and visual acuity can identify 20% of the cohort as at high risk, 75% of them from clinical factors only, and the rest after BMD measurements (threshold: -2.5 T-score). The triage strategy would be significantly more sensitive than systematic BMD screening (51 versus 35%) and would require many fewer BMD examinations (10%). Compared with current recommendations, triage would identify fewer women (20 versus 28%) but at a significantly higher average risk of hip fracture (30 versus 20 per 1000 woman-years). Fewer high-risk women would be treated to prevent one hip fracture (29 versus 41) and fewer bone densitometry tests would be needed (10% versus 54%). The proposed triage strategy may be a useful clinical tool for selecting elderly women for treatment or bone densitometry.

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